Coaching Application

If you are looking for a coach or you are simply in need of a remarkable training program, then do not hesitate to connect with us by filling out the application below:

First Name:

Last Name:

Address:

City:

State:

Zip:

Cell Phone:

Email Address:

Company:

Title:

Are you a business owner?

Type of business:

What is your annual income?

What is your desired annual income?

Please share with us a description of your job and duties. Include the biggest challenges you face in your business:

On a scale of 1 -10 (10 being peak performance), please rate the following areas of your business at the present time (where applicable):

Career Performance

You have rated this category a 7 or lower, please share what a 10 looks like in your mind and how you feel your life would be impacted if you were performing at a 10 in this category. Please be detailed in your response.

Career Performance Comments

Time Management

You have rated this category a 7 or lower, please share what a 10 looks like in your mind and how you feel your life would be impacted if you were performing at a 10 in this category. Please be detailed in your response.

Time Management Comments

Work Ethic

You have rated this category a 7 or lower, please share what a 10 looks like in your mind and how you feel your life would be impacted if you were performing at a 10 in this category. Please be detailed in your response.

Work Ethic Comments

Balance in Life

You have rated this category a 7 or lower, please share what a 10 looks like in your mind and how you feel your life would be impacted if you were performing at a 10 in this category. Please be detailed in your response.

Balance in Life Comments

Physical Health and Well Being

You have rated this category a 7 or lower, please share what a 10 looks like in your mind and how you feel your life would be impacted if you were performing at a 10 in this category. Please be detailed in your response.

Physical Health and Well Being Comments

Relationship with others

You have rated this category a 7 or lower, please share what a 10 looks like in your mind and how you feel your life would be impacted if you were performing at a 10 in this category. Please be detailed in your response.

Relationship with others Comments

Relationship with yourself

You have rated this category a 7 or lower, please share what a 10 looks like in your mind and how you feel your life would be impacted if you were performing at a 10 in this category. Please be detailed in your response.

Relationship with yourself Comments

Time For Yourself

You have rated this category a 7 or lower, please share what a 10 looks like in your mind and how you feel your life would be impacted if you were performing at a 10 in this category. Please be detailed in your response.

Time For Yourself Comments

How many hours are you currently working per week (including mental time away from the office)?

How many hours do you want to work per week ideally?

What brings you the most joy in life?

Have you had professional coaching in the past (including Life and Business Coaching)?

If yes, please indicate the name your previous coach and the company and briefly describe your experience.

Please share with us your top three reasons for wanting to be coached by our firm.

If your coaching with us were to conclude, what would your life look like in your ideal scenario?